Some of the functions of the PLAIN summaries work best on the desktop version. We are currently working on optimizing the mobile version.
Other PLAIN summaries
- Asymptomatic coronary artery disease
- Bone problems
- Cancer-related fatigue
- Central precocious puberty – CPP
- Chronic pain
- Craniofacial growth problems
- Dental and oral problems
- Dyslipidemia
- Eye problems
- Gastro-intestinal problems
- Hair loss
- Health promotion
- Hearing problems
- Heart problems
- Higher risk groups
- HP axis problems
- Hypertension
- Impaired glucose metabolism and diabetes
- Kidney problems
- Liver problems
- Lower urinary tract problems
- Lung problems
- Male fertility problems, testosterone deficiency and sexual dysfunction
- Mental health problems
- Neurocognitive problems
- Obstetric problems
- Overweight and obesity
- Peripheral neuropathy
- Premature ovarian insufficiency
- Psychosocial problems
- Spine scoliosis and kyphosis
- Spleen problems
- Stroke
- Subsequent neoplasms:
- Thyroid problems
CANCER-RELATED FATIGUE
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
- Cancer-related fatigue
- Am I at higher risk of cancer-related fatigue?
- What are the symptoms and signs of cancer-related fatigue?
- I am at higher risk of cancer-related fatigue. What tests should I have and when?
- What happens if I have cancer-related fatigue?
- What else can I do?
- Where can I find more information?
- Please note
This PLAIN summary is based on the PanCareFollowUp guideline for “Cancer-related fatigue” [1], which is itself based on the corresponding IGHG* guideline [2].
PLAIN version 2.1: 27/05/2024
Cancer-related fatigue
Everyone feels tired from time to time. This is perfectly normal, especially when tiredness has an identifiable cause such as being busy at school or work or after extensive exercise. Compared to normal tiredness, fatigue is much worse and not relieved by rest.
Childhood cancer and its treatment can cause fatigue (this is called cancer-related fatigue). Usually cancer-related fatigue gets better after treatment finishes, but sometimes it lasts for many months or even years. When you constantly feel fatigued and it does not get better with rest, this can have a big impact on your daily life and emotional wellbeing.
Am I at higher risk of cancer-related fatigue?
Anyone, including people who have never had cancer treatment, may develop fatigue. The difference with cancer-related fatigue is of course it only occurs to people after a diagnosis with cancer.
The following factors may increase the risk or severity of cancer-related fatigue:
- Psychological distress
- Late effects of childhood cancer or treatment
- Radiotherapy
- Other health problems such as pain
- Cancer relapse or a new cancer diagnosis
- Getting older
You can find out if you have received radiotherapy by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you experience fatigue, it does not always mean that this is caused by your cancer or its treatment. Fatigue may have other causes. It is often difficult to distinguish ‘normal’ fatigue from cancer-related fatigue.
Other causes
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of cancer-related fatigue?
There are symptoms and signs that may suggest you could be experiencing cancer-related fatigue. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you experience fatigue:
- Tiredness or exhaustion without identifiable cause
- Feeling like you have no energy or strength
- Difficulty doing simple things, such as brushing your hair or getting dressed
- Reduced motivation
- Difficulty concentrating and remembering things
- Difficulty sleeping (insomnia)
- Losing interest in sex
- Feeling anxious, depressed or moody
- Finding it hard to make decisions
- Appetite loss or overeating
Usually these symptoms are temporary and will usually go away after plenty of rest. However, if you experience any of these symptoms or signs for a longer time period please see a general practitioner or follow-up care specialist.
Symptoms and signs
I am at higher risk of cancer-related fatigue. What tests should I have and when?
Whenever you visit your follow-up care specialist, they may:
- Ask whether you have been experiencing any symptoms and/or signs of cancer-related fatigue
If you feel you may have cancer-related fatigue, it is advised to speak to your general practitioner or follow-up specialist. They may ask about your lifestyle, your feelings of tiredness and exhaustion. They may also screen for underlying medical conditions that may cause fatigue such as anaemia, sleep disorder, or underactive thyroid (hypothyroidism).
Anaemia
What happens if I have cancer-related fatigue?
If you experience cancer-related fatigue, your follow-up care specialist or general practitioner will probably refer you to a specialist. Depending on the symptoms and/or signs you experience, you may be referred to a:
- Specialist in fatigue (if available)
- A more generic specialist such as
- Psychologist (healthcare professional specialised in mental health)
- Physiotherapist (healthcare professional specialised in exercise)
- Counsellor (professional specialised in provides guidance and advice)
The specialist may discuss different options with you such as education programmes about cancer-related fatigue, physical exercise, adventure-based training, cognitive behavioural therapy, relaxation or mindfulness.
What else can I do?
Experiencing cancer-related fatigue can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
Although it may not influence cancer-related fatigue, it is still important to live a healthy lifestyle. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing cancer-related fatigue and that you know the symptoms and signs. If you have any further questions or the information in this brochure worries you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about (cancer-related) fatigue online. However, it is important to be aware that this information is not always up to date or accurate.
Some sources of further information are:
- NHS inform: Here you can find more information about managing cancer-related fatigue
- American Cancer Society: Here you can find more information about cancer-related fatigue in general
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline for “Cancer-related fatigue” [1], which is itself based on the corresponding IGHG* guideline [2].
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
*International Guideline Harmonization Group for Late Effects of Childhood Cancer
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext
[2] Christen, S. et al. (2020) Recommendations for the surveillance of cancer-related fatigue in childhood, adolescent, and young adult cancer survivors: a report from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Available at: https://link.springer.com/article/10.1007/s11764-020-00904-9